Dr. Duane Keller Inventor of Perio Protect: September 2011

I think it is important for readers to understand that you may not be at fault for your gum disease (unless you don't at least try to brush and floss). The following are exact excerpts from the dental literature that demonstrate even if you follow the directions of your dentist you may not be able to adequately control the cause of gum disease that is also associated with a host of systemic complications.

This first one is an excerpt from a professional journal. Every possible treatment was done and they evaluated the bacterial (cause) results at one year. No one is going to do all of these steps, but even with this the bacteria that cause the disease are prevalent at one year. How can people be responsible if we (the dental profession) don’t give the patient the tools to control the disease.

ž Conventional Care:

Shiloah J, Patters MR, Dean JW 3rd, Bland P, Toledo G J Periodontol. 1998 Dec;69(12):1364-72

The prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, and Bacteroides forsythus in humans 1 year after 4 randomized treatment modalities. 1) scaling and root planing; 2) pocket reduction through osseous surgery and apically-positioned flap; 3) modified Widman flap; and 4) modified Widman flap and topical application of saturated citric acid at pH 1 for 3 minutes.

Patients rinsed with 0.12% chlorhexidine for the first 3 months postoperatively and received a prophylaxis every 3 months.

The choice of treatment modality did not affect the prevalence of the target species at 1 year post-treatment. These results suggest that prevalence of microbial pathogens negatively affects the 1 year outcome of periodontal surgical and nonsurgical therapy.

This second one was the results from the University of Florida that was presented at one of the major research meetings. The bacteria (cause of gum disease) were found to be the same in the periodontal pocket before and after professional (gold standard scaling and root planing) cleaning. How can the patient control the disease if we the profession leave the cause in place?

Conventional Care:

Differences between Biofilm Growth Before and After Periodontal Therapy

Resposo S et al. University of Florida, Gainesville, FL

Objective: The purpose of this study was to evaluate in vitro subgingival biofilm growth from plaque samples collected before and after scaling and root planing (SRP). Methods: Subgingival samples were collected before and after SRP from a 5mm pocket or greater with bleeding, along with 5ml of saliva from 9 patients diagnosed with chronic periodontitis. Calcium hydroxyapatite discs were coated with 10% filtered sterilized saliva for 2hrs, placed in 5ml of Trypticase Soy Broth (TSB) and innoculated with 100ul of dispersed subgingival plaque. Biofilms were grown anerobically at 37ºC for up to 10 days with transfer to fresh medium at 48 hour intervals. Biofilms were then processed at specific intervals for total viable counts and the species present were evaluated and semi-quantified by DNA-DNA hybridization. Biofilm composition was also analysed by Scanning Electron Microscopy (SEM). Results: Samples taken before SRP harbored more bacteria than after SRP (10⁷ versus 10⁶, p=0.004). However, both sets of biofilms grew at a similar rate, reaching a peak CFU of ~10⁸ cells as early as day 3 (p>0.05). Samples taken after SRP presented the same species as those samples taken previous to the procedure, but in less quantity (p<0.001). Greater amounts of red complex bacteria and A.actinomycetencomitans (~10⁴) were found both before and after SRP when compared to other species (~10²). SEM analysis showed growth of a complex structure comprised of rods, cocci,fusiforms and filaments in both sets of mature biofilms.

Conclusion: Subgingival biofilms before and after SRP treatment present the same composition of bacterial flora and are able to grow similarly if given proper conditions. Therefore, subgingival bacteria that remains after SRP therapy has the potential to recolonize to pretreatment levels if not properly maintained.

If you the patient do what we (dental profession) tell you and you still suffer a deterioration of the disease over time it is because you were not compliant? A patient has to be compliant, but you also have to be shown a method that works!

J Clin Periodontol. 2003;30 Suppl 5:4-6.

Improving oral health: current considerations.

Ciancio S.

School of Dental Medicine, University of Buffalo, SUNY, Buffalo, NY 14214, USA.

The high incidence of periodontal disease among adults in the Western world indicates that in most cases, routine dental care could be considerably improved. The progressive effect of the disease suggests that improvements in oral cleanliness are mandatory if large numbers of adults are to retain their teeth into old age. Data show that periodontal disease can be minimized through effective plaque control, and that a combination of brushing, interdental cleaning, and chemotherapeutic agents (e.g. mouthwash) is beneficial to patients with plaque control problems. The vast majority of adults do not follow an adequate home-care routine. Average brushing times are low, and only a minority of patients regularly floss. In addition, in those patients who do regularly brush and floss, a deterioration of plaque control occurs over time, suggesting that compliance is a major issue. The principal challenge for dental professionals is to identify how best to elicit an improvement

I do agree with his last sentence that we have to find a way to elicit an improvement.

Our research published in the Journal of Dental Research 2007, Vol 86 show we kill 99.98% of the bacteria in 17 days that are in the periodontal pocket (the same bacteria left in the first two articles). Perhaps patients do not need to beat themselves up, but realize they now have a choice which works.

Later I will post some excerpts that illustrate just how related these bacteria relate to cardiovascular disease, pre-term low birth weight, Alzheimer’s disease, arthritis, cancer, stroke, etc.

Duane Keller DMD

Bacteria divide every 15-20 minutes in the mouth. 1 bacteria in 24 hours will = 5,000 Billion, Billion. Unless..... YOU DON"T LET THEM!!!!

The goal of the Perio Protect Method™ is to promote lasting oral health without requiring repetitive invasive procedures.

What about the bacteria under the gum tissue? Mouth rinse can't kill the bacteria under the gum tissue, and mouth rinse only kills bacteria while you are rinsing.

In 2003 the World Health Organization published a comprehensive report on oral health showing that more than 80% of adults in the U.S. have some form of gum disease. Unfortunately most of these people don't know it.

How does the disease start? click on the following link http://www.perioprotect.com/serious.asp

Perio Protect® is a comprehensive method that is customized for individual patients to help manage biofilms, communities of bacteria, growing in the spaces or pockets between teeth and gum tissue. The overall goal of the Perio Protect Method™ is to manage oral biofilm with minimally invasive dentistry for lasting oral health.

The Method is a combination of treatments, including a non-invasive chemical debriding therapy used in conjunction with traditional mechanical debriding procedures. The chemical therapy involves a tray delivery of doctor-prescribed solutions to chemically debride biofilm from the periodontal pocket and alter the pocket's microbiological environment to disrupt biofilm growth.

The standard cleaning procedures in dental offices (e.g. scaling and root planing) help remove plaque and tartar and help reduce bacteria, but unfortunately bacteria reproduce quickly and biofilms regenerate very easily, so it is difficult to control them between office visits.

With the Perio Protect Method, you can place prescribed solutions into periodontal pockets with an appropriately formed, customized dental tray between office visits to help manage biofilm. Although a dentist must choose the most appropriate solution for individual patients, the most commonly prescribed solution with the Method has oxidizing and oxygenating agents. Oxidizing agents debride (chemically remove) the slimy protective coating of a biofilm and its underlying layers and also cleanse the oral wounds.

Dentists may choose to treat the oral wounds with the chemical debriding and cleansing agents before mechanical debriding procedures to help reduce bacterial populations and thus reduce the risk of introducing bacteria into the bloodstream during mechanical debridement.

For most people following the Perio Protect Method, the placement of prescribed solutions into a periodontal pocket via a customized prescription tray requires only minutes each day. Patients describe the tray delivery as comfortable and appreciate its non-invasive technology.

The actual combination of mechanical treatment, chemical therapies, and prescribed treatment plan is determined by a dentist evaluating your specific conditions. To Learn more about the Perio Protect Method click on the following link http://perioprotect.com/.

Want to know if you have gum disease? Come on in for a free consultation normally valued at $265.00! Just call 314-638-4190. (offer only valid at Dr. Duane Keller's dental practice)

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